Choosing Wisely Conversations Take Center Stage in Minnesota

July 9, 2014

The Choosing Wisely campaign promotes conversations on overuse and waste in our health care system. However, before many physicians are able to engage in these conversations with their patients they need to become more comfortable with shared decision-making and refine their communication skill set. The Minnesota Medical Association, a grantee of the ABIM Foundation, partnered with the Guthrie Theater to create an innovative approach to understanding and changing the behavior of physicians as they interact with their patients.

“Choosing Wisely’s emphasis on communication as the foundation for more informed decision-making resonated with us. Effective communication is a well-documented gap in the skills of many physicians. We wanted to help physicians improve these skills in a unique and interactive way,” said Janet Silversmith, Director of Health Policy at the Minnesota Medical Association. “The Guthrie Theater in Minneapolis has a tradition of connecting health care and the arts. Choosing Wisely was a perfect opportunity for us to partner with the Guthrie in applying actors’ communication techniques to the physician-patient relationship and the critical conversations that occur about care choices and options.”

Research shows that more than 90 percent of the impact of a message results from non-verbal influences. The Guthrie Theater’s Theater and the Healing Arts program is renowned for improving physician communication by helping physicians better understand their non-verbal cues and how they affect their patients. The Theater and the Healing Arts program has worked with notable institutions such as the Mayo Clinic and the University of Minnesota on topics such as vaccine use and substance abuse issues.

The Minnesota Medical Association partnered with Theater and the Healing Arts to create a physician communication workshop designed to help clinicians:

maximize productivity in patient visits;

improve communication with patients;

foster shared decision-making and support; and,

illustrate how communication skills can be used in conversations about Choosing Wisely – how to talk about the best tests, treatments and procedures for a specific patient.

The free workshop was created specifically as the centerpiece of the Minnesota Medical Association’s Choosing Wisely learning network, consisting of local physician practices interested in implementing the campaign in their clinical settings. The first two of four workshops in the series were held in April.

During the four-hour training, physicians from multiple specialties focused on improving a number of non-verbal cues to make their patients feel more comfortable, including body language and breathing. The instructors explained that breathing patterns are often unconsciously mimicked by a patient and can help set a relaxed conversation tone. Physicians at the workshop also became attuned to how a quick and busy gait when entering an exam room may set the wrong tone for the patient exam.

Through role-playing exercises and feedback from instructors, physicians built on these skills throughout the training. Participants also practiced eye contact and positive speech patterns to help build trust and reinforce verbal instructions.

“[This was a] great presentation of skills we will all need to employ in changing patient expectations and serving as good stewards of health care resources,” said one of the attendees.

Complementing Minnesota Medical Association’s efforts in this area, the ABIM Foundation worked with Drexel University College of Medicine to develop a set of interactive physician communication modules to enhance physician and patient communication around specialty society recommendations. The modules are designed to help physicians, patients and other health care stakeholders think and talk about overuse of health care resources by providing strategies for physicians to build trust and address patient attitudes and beliefs that more care is not always better care.